Impacto do declínio cognitivo pós‐operatório na qualidade de vida: estudo prospectivo
Bibliographic record
Abstract
Independentemente do progresso do tratamento no período perioperatório, o declínio cognitivo no pós‐operatório (DCPO) é inequivocamente aceito como uma complicação importante e frequente da cirurgia em pacientes mais velhos. O objetivo deste estudo foi avaliar a incidência de DCPO e sua influência na qualidade de vida três meses após a cirurgia. Estudo prospectivo observacional conduzido em Sala de Recuperação Pós‐Anestesia (SRPA) com pacientes de idade superior a 45 anos, após cirurgia eletiva de grande porte. A função cognitiva foi avaliada com o teste de Avaliação Cognitiva de Montreal (MOCA) e a qualidade de vida (QV) com o Questionário sobre Qualidade de Vida (SF‐36). As avaliações foram feitas no pré‐operatório (T0) e três meses após a cirurgia (T3). Foram avaliados 41 pacientes. A incidência de DCPO três meses após a cirurgia foi de 24%. Em T3, os escores MOCA foram menores nos pacientes com DCPO (mediana 20 vs. 25, p = 0,009). Ao comparar as medianas dos escores para cada um dos domínios do SF‐36, não observamos diferenças entre os pacientes com e sem DCPO. Ao comparar cada um dos domínios do SF‐36 obtidos antes e após três meses de cirurgia, os pacientes com DCPO apresentaram resultados semelhantes para cada uma das oito áreas do SF‐36, enquanto pacientes sem DCPO apresentaram resultados melhores em seis domínios. Em T3, os pacientes com DCPO apresentaram níveis mais elevados de dependência nas atividades cotidianas. Três meses após a cirurgia, os pacientes sem DCPO apresentaram melhoria significativa dos escores MOCA. Os pacientes com DCPO não apresentaram aumento dos escores SF‐36, mas os pacientes sem DCPO apresentaram melhora em quase todos os domínios do SF‐36. Os pacientes com DCPO apresentaram taxas mais elevadas de dependência na realização de atividades cotidianas após a cirurgia. Regardless the progress in perioperative care postoperative cognitive decline (PCD) has been accepted unequivocally as a significant and frequent complication of surgery in older patients. The aim of this study was to evaluate the incidence of postoperative cognitive decline and its influence on quality of life three months after surgery. Observational, prospective study in a Post‐Anesthesia Care Unit (PACU) in patients aged above 45 years, after elective major surgery. Cognitive function was assessed with Montreal Cognitive Assessment (MOCA); Quality of life (QoL) was assessed using SF‐36 Health Survey (SF‐36). Assessments were performed preoperatively (T0) and 3 months after surgery (T3). Forty‐one patients were studied. The incidence of PCD 3 months after surgery was 24%. At T3 MOCA scores were lower in patients with PCD (median 20 vs. 25, p = 0.009). When comparing the median scores for each of SF‐36 domains, there were no differences between patients with and without PCD. In patients with PCD, and comparing each of SF‐36 domains obtained before and three months after surgery, had similar scores for every of the 8 SF‐36 areas while patients without PCD had better scores for six domains. At T3 patients with PCD presented with higher levels of dependency in personal activities of daily living (ADL). Three months after surgery patients without PCD had significant improvement in MOCA scores. Patients with PCD obtained no increase in SF‐36 scores but patients without PCD improved in almost all SF‐36 domains. Patients with PCD presented higher rates of dependency in personal ADL after surgery.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".